{% include "site/reg_header.html" %}
<style type="text/css">
    .t_m{
        background-color:black;
        width:720px;
        padding:3px;
    }
    .top-left{
        width:350px;
        height:450px;
        background-color:#8f8f8f;
        text-align:center;
    }
    .top-right{
        width:350px;
        height:450px;
        background-color:#8f8f8f;
        text-align:center;
    }
    .bottom-left{
        width:350px;
        height:450px;
        background-color:#8f8f8f;
        text-align:center;
    }
    .bottom-right{
        width:350px;
        height:450px;
        background-color:#8f8f8f;
        text-align:center;
    }
</style>

<div style="width:1080px;">
<div style="float:right; position:fixed; top:120px; left:750px;">
<form>
<table cellspacing="3" cellpadding="3" border="0">
    <tr>
        <td><h4>Why did you chose that image?</h4>Please select all that apply:</td>
    </tr>
    <tr>
        <td>
            <table cellspacing="3" cellpadding="3" border="0">
                <tr>
                    <td><input type="checkbox" name="ear" value="ear" />Ear(s)</td>
                    <td><input type="checkbox" name="hair" value="hair"/>Hair</td>
                    <td><input type="checkbox" name="nose" value="nose"/>Nose</td>
                </tr>
                <tr>
                    <td><input type="checkbox" name="marks" value="marks"/>Markings</td>
                    <td><input type="checkbox" name="wrinkles" value="wrinkles"/>Wrinkles</td>
                    <td><input type="checkbox" name="eyebrows" value="eyebrows"/>Eyebrow(s)</td>
                </tr>
            </table>
        </td>
    </tr>
    <tr>
        <td>Additional Comments:</td>
    </tr>
    <tr>
        <td>
            <textarea cols="40" rows="4" name="comments"></textarea><br />
            <input type="submit" name="submit" value="Submit" />
        </td>
    </tr>
</table>
</div>
<div class="t_m">
    <i style="color:white;">Select the closest matching scan</i>
    <table cellspacing="3" cellpadding="3" border="0">
        <tr>
            <td><div style="background-color:#3f3f3f; color:white;">Original</div><div class="top-left"></div></td>
            <td><div style="background-color:#3f3f3f; color:white;"><input style="float:right;" type="radio" name="r" value="c1" />Canvas #1</div><div class="top-right"></div></td>
        </tr>
        <tr>
            <td><div style="background-color:#3f3f3f; color:white;"><input style="float:right;" type="radio" name="r" value="c2" />Canvas #2</div><div class="bottom-left"></div></td>
            <td><div style="background-color:#3f3f3f; color:white;"><input style="float:right;" type="radio" name="r" value="c3" />Canvas #3</div><div class="bottom-right"></div></td>
        </tr>
    </table>
</div>
</form>
</div>
<table cellspacing="3" cellpadding="3" border="0">
    <tr collspan="2">
        <th>Having trouble?</th>
    </tr>
    <tr>
        <td>Tutorial stuff <a href="#">here</a></td>
        <td>Help Center <a href="#">here</a></td>
    </tr>
</table>
{% include "site/footer.html" %}
